May 2009
2018 >> $5
December
ON ROUNDS
New Guy in Town
‘Rewarded’ With
Heavy Challenge
When Dr. Sanjeev Kumar
came to Memphis he found
a heavy
problem
awaiting
him – literally.
The doctor
who had a
fellowship in
gynecology/
Sanjeev Kumar
oncology was
seeing many obese patients,
fortunately for everyone.

Profile on page 3.

Patients, Caregivers
Welcome Increased
Alzheimer’s Funding
New research funding
and the laws to support
patients and
caregivers
enhance the
efforts of the
Alzheimer’s
Association to
meet its goal
Rachel Conant
to prevent or
effectively treat the disease
by 2025.

Editor’s note: Five chief nursing officers from five Memphis hospitals were invited by
the Memphis Medical News to participate in a
roundtable discussion during a luncheon at the new
G Alston Restaurant in Cordova. The publication
has gleaned the group’s critical and compassionate
assessment of key nursing issues and transposed the
remarks into this feature-length article in honor of
the profession many call “the heart of healthcare.”
The month of May celebrates nursing and includes
National Nurses Week.
As the top nursing management professional in any healthcare organization, the
chief nursing officer (CNO) must wear many
hats and work with other healthcare leaders
to establish policies that benefit the entire
nursing staff and improve clinical care.
Now more than ever, CNOs play a vital
role and offer unique clinical insights in day(CONTINUED ON PAGE 8)

Sustainable Solutions Considered
For Possible Physician Shortage
By CINDY SANDERS

Memphis hospitals win
awards, a new health care
building opens its doors, and
a report that Tennessee is
making strides in the opioid
battle are some of the stories
in Grand Rounds.

Complex problems rarely have simple solutions.
Such is the case with the looming physician shortage
facing the United States.
New research published last month by the Association of American Medical Colleges (AAMC) shows
increasing shortages looming for both primary and
specialty care.
The new data outlined in the 2018 update of “The
Complexities of Physician Supply and Demand: Pro-

jections from 2016-2030” provides a forecast based on
a number of supply and demand scenarios, including
an aging population on the demand side and heavier
reliance on other physician extenders on the supply
side.
Recognizing it is impossible to accurately predict
exactly how market forces will play out over the coming years, each supply scenario is paired with a demand
scenario to create a projected shortfall range.
Part of AAMC’s commitment to annually updat(CONTINUED ON PAGE 4)

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>

WCC18_007_MemMedNews_10x13_r2.indd
1
MAY 2018

m e m p h i s m e d i c a l 3/26/18
n e w s 4:15
. c oPM
m

PhysicianSpotlight

Taking On Tough Task of Obesity Surgery
Sanjeev Kumar Found Right Place to Put Laparoscopy, Robotics into Practice
By LAWRENCE BUSER

When Dr. Sanjeev Kumar came to
Memphis in 2013 after a fellowship in
gynecology/oncology at the Mayo Clinic,
he found a patient population of heavyweights.
With Dr. Kumar’s expertise in
robotic and laparoscopic surgery, the
Baptist Medical Group Gynecology Surgical Center soon became ground zero for
obese patients, a group that poses a greater
degree of difficulty in surgical procedures.
“When I came to Memphis, we
started getting these challenging patients
and it was like ‘Let the new guy in town
have these difficult cases that nobody else
wants,’” Dr. Kumar recalled. “Gradually
we started developing methods and I
started training my staff and operating
team, and we started getting excellent
results in very obese patients.
“Now in my practice, 80 to 90 percent of my patient population is obese. A
lot of other physicians do not feel comfortable dealing with very obese patients, but
with the surgery we’re offering we have
seen the dramatic impact this makes in
the patients’ lives.”
Obesity is measured by Body Mass
Index (BMI), which is the weight in kilograms divided by the square of height in
meters. Generally, 18 to 25 BMI is normal, somewhat above that is overweight
and higher than 30 BMI is obese.
According to the Centers for Disease Control, two-thirds of Americans are
overweight, while more than a third are
obese.
Under the blunt headline “The Fattest Cities in America,” an online publication called WalletHub regularly has
Memphis and surrounding metro areas in
its top five. Last year the top three were
Jackson, Mississippi; Memphis and Little
Rock.
“We figured if we’re going to do obesity-related work, we are in the right geographic region,” Dr. Kumar said. “There
is a lot of need for robotic pelvic surgery in
obese women. With open surgery in obese
patients, you have to cut through more
skin, more flesh and therefore you have a
much higher rate of infection.
“The greater fat tissue has a lower
blood supply, so the healing is slower, you
may have long-term wound-care problems and things like that. Robotic surgery
eliminates all of those problems to a great
extent, and that’s a big advantage.”
While some 60 percent of the practice
is hysterectomy surgery, Dr. Kumar and
his team also perform robotic procedures
for ovarian tumors and cysts, cervix and
uterine cancer, and other pelvic-region
surgeries.
Gynecologic cancer, pelvic pain,
heavy bleeding and fibroids are other
common problems that can be cured with
MEMPHISMEDICALNEWS

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robotic pelvic surgery, the doctor added.
He said laparoscopic or robotic surgeries
are better methods than open surgery for
treating such problems.
Like laparoscopic or keyhole
surgery, robotic surgery begins with a few
dime-sized incisions in the abdomen, but
mechanical arms with surgical instruments
become extensions of the surgeon. The
first robotic surgery system was approved
by the FDA in 2000.
Looking through a magnified, 3D
high-definition camera, the surgeon can
literally do some heavy lifting with the sur-

gical arms by raising the abdominal wall
of an obese patient to better observe the
operating field.
The robotic arms also offer
360-degree movement of the surgical
instruments, which are manipulated by
the surgeon as he cuts, cauterizes, sews
and dissects tissue.
“It’s a combination of dexterity and
computer knowledge, plus a fair bit of eyehand coordination is required, and obviously lots of practice,” said Dr. Kumar,
who estimates he has performed some
4,000 robotic pelvic surgeries. “Robotic
surgery actually started with the U.S. military, which was looking at the concept of
having a surgeon on a ship or city being
able to take care of soldiers on a battlefield
without physically being there. That’s how
a lot of robotic surgery concepts evolved,
but that’s not the routine clinical practice.”
He said patients routinely worry that
the doctor will not be in the operating
room at all and that the surgery will be
performed by a robot with a mind of its
own.
“Some people will come in and say ‘I
want to have the surgery, but I want to see
the robot first,’” Dr. Kumar said. “They
want to make sure a human is controlling
the robot. I tell them that I’ll be right there
controlling the robot myself. It’s not the
robot that’s doing the surgery.

“My fascination with surgery began
when I was a kid growing up on a farm
in India driving tractors. I wanted to do
something manual. I thought I would be
good at something where I could work
with my hands.
“I went to medical school in India
and got my training in robotic and laparoscopic surgery at the Mayo Clinic. That
instilled the belief in me that I could really
do these challenging cases, especially since
there’s such a need for them.”
He points out that in its annual honor
roll rankings, U.S. News and World Report
last year ranked the Mayo the No. 1 hospital in six specialties, including gynecology.
Dr. Kumar has an older brother who
is a farmer and a sister who is an attorney,
both living in India. He and his wife, who
uses only one name, is Dr. Sumedha, an
internist at Baptist Hospital. They have a
daughter, 7, and a son, 3.
Whether the children follow their
parents into the medical field will be up
to them.
“This is such a fascinating and satisfying field that I would love to encourage
them to enter the medical profession and
explore being surgeons as career options,”
Dr. Kumar said. “But honestly, I want to
encourage them to develop whatever they
want to do. That’s when you do the best
work, when it comes from within your
heart and your mind.”

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Searching for Sustainable Solutions, continued from page 1
ing physician workforce projections, the
latest report increased the forecasted physician shortfall to between 42,600 and
121,300 by 2030. This is up from last
year’s report, which projected a physician shortfall of 40,800 to 104,900 by that
same year. The shifting demographics of
the U.S. population continue to be a key
driver of demand.
“Our data shows by 2030, the U.S.
population aged 65 and older will grow
by 50 percent,” said AAMC’s Chief Public Policy Officer Karen Fisher. She added
the supply side of the equation is impacted
by several factors including the hours physicians are willing to work, the number
of providers nearing retirement, and the

quantity of young physicians completing
training to fill in those gaps.

Schools Step Up

Allopathic and osteopathic medical schools have both seen increases in
enrollment over the last several years as
academic centers have pledged to help
alleviate projected workforce shortages.
According to AAMC data, there were
21,338 new enrollees in allopathic medical schools for the 2017-2018 academic
year, a 1.5 percent increase over the previous year. Total enrollment for 2017-18
was 89,904 students compared to 81,936
in the 2012-13 year, a nearly 10 percent
increase over the last five years and closer

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to a 20 percent increase over enrollment
a decade ago.
The American Association of Colleges of Osteopathic Medicine (AACOM)
saw first-year matriculation jump with
a nearly 7 percent increase in fall 2017
enrollment over the prior year. Preliminary figures from AACOM placed 2017
total enrollment at 28,981, an all-time
high for the 34 accredited colleges of
osteopathic medicine in the United States.

GME Bottleneck

While growing medical school enrollment is a positive step, Fisher and colleagues point out increasing the number
of students won’t translate into more physicians and surgeons if there aren’t adequate training slots for graduates.
“The Medicare program has been a
key financer of graduate medical education,” said Fisher, who added Medicare
historically funded GME on a proportionate share of a resident’s training. For
example, if a resident trained at a facility
where Medicare made up 30 percent of
the patient population, then the federal
program would pay 30 percent of the physician’s GME cost.
However, continued Fisher, “In
1997, Medicare placed a cap on that support … so for over 20 years, Medicare’s
support has been capped at the number
of residents in 1996.” For every resident
above the hospital’s cap, she said, the
facility has had to absorb that extra cost.
“It’s like they are taking a cut every
year by virtue of that cap,” Fisher added.
For the most part, she continued,
there have been slots available for graduates because hospitals have borne the
additional training costs. In some cases,
states have stepped in to help with additional funding, as well. However, Fisher
said sustaining the current setup is an
ongoing concern.
“When clinical revenues get tight,
we’re very concerned about the ability
of teaching hospitals to continue to train
residents above the cap,” she said. “It’s
important that we continue to receive

WE
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MAY 2018

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stable, predictable financing to offset the
significant costs associated with training
new physicians.”
AAMC, along with AACOM,
strongly supports legislation that would
moderate the chilling effect the current
cap has on physician training. “We’re
asking for 3,000 residency positions each
year for five years for a total of 15,000 residency positions,” noted Fisher.
The bipartisan Resident Physician
Shortage Reduction Act of 2017 (HR
2267, S 1301) was introduced last May
but didn’t make it out of committee. However, Fisher said there might be another
chance to gain some traction if Congress
takes up infrastructure this year. “I think
the physician workforce is an important
infrastructure need for the health of our
country,” she said.

Other Options

AAMC officials have repeatedly
stressed the need for a multi-pronged
approach to addressing the physician
shortage. While enrollment and GME are
huge components to the solution, there
are other factors being addressed, as well.
“Overall, our modeling certainly
looks at the role and growth of nurse
practitioners, physician assistants and
telehealth,” she said of utilizing teams and
technology to extend the delivery system.
AAMC also supports non-GME
incentives and programs, including
Conrad 30, the National Health Service
Corps, loan forgiveness programs and
Title VII/VIII, which are used to recruit
a diverse workforce and encourage physicians to practice in shortage specialties
and underserved communities.
Fisher said foreign-born physicians
are another potential part of the solution
and noted those trained outside of America must undergo a rigorous assessment
before being allowed to practice in the
United States.
“They are an important source of
physicians in this country,” she said.
“Many of them tend to practice in rural
and underserved areas,” she added of filling gaps in care. Additionally, AAMC has
been a champion of increasing the physician workforce in a manner that embraces
diversity and cultural competency to mirror the nation’s changing demographics
and to work towards eliminating health
disparities.
Fisher noted the AAMC also has
released several statements calling for
healthcare workers with DACA status to
be able to continue their education, training and research. Similarly, the organization has expressed concerns over executive
actions on immigration and travel impacting researchers and clinicians. In an issue
brief from March 17, 2018, the organization noted, “Because disease knows no
geographic boundaries, it is essential that
we continue to foster, rather than impede,
scientific cooperation with clinicians and
researchers of all nationalities as we strive
to keep our country safe from all threats.”
Fisher concluded, “We certainly support national security, but we believe this
is an issue of national health security.”
MEMPHISMEDICALNEWS

.COM

Leaders in Women’s Healthcare
Introducing the Next Decade of
McDonald + Murrmann

Alzheimer’s
Association Sees
Increase in
Federal Support

Patients, Researchers, Caregivers All Score Wins
By CINDY SANDERS

In March, President Donald Trump
signed a massive $1.3 trillion omnibus
spending bill into law to fund the federal
government. Part of the spending package included a $414 million increase for
Alzheimer’s and dementia research funding at the National Institutes of Health
(NIH).
Rachel Conant, senior director of
Federal Affairs at the Alzheimer’s Association, leads the
organization’s efforts
to elevate Alzheimer’s
disease as a priority
for the federal government. She also
serves as senior political director of the
Alzheimer’s Impact
Rachel Conant
Movement (AIM),
which is the national association’s advocacy arm.
“The Alzheimer’s epidemic has a
profound impact on families,” she said,
adding her own family had been touched
by the disease. “The Alzheimer’s epidemic has a profound implication for
state and federal budgets,” Conant continued. “Nearly one in every five Medicare dollars is spent on Alzheimer’s or
related dementias.”

Alzheimer’s Stats

Just days before the spending bill
was signed, the Alzheimer’s Association
released a new report outlining the toll of
the disease. “The 2018 Alzheimer’s Disease Facts and Figures” found increases
memphismedicalnews

.com

in prevalence, deaths and cost of care. An
estimated 5.7 million Americans are living with Alzheimer’s dementia in 2018,
nearly two-thirds of Americans with
Alzheimer’s are women, 10 percent of
those 65 and older have the disease, and
the incidence rates are even higher in
older African-Americans and Hispanics.
Alzheimer’s cases are expected to spike
alongside the nation’s aging population
with an estimated 14 million living with
the disease by 2050. Currently, someone
in the United States develops Alzheimer’s
every 65 seconds. The Alzheimer’s Association predicts by mid-century, someone
will develop the disease every 33 seconds.
Although deaths from other major
diseases have decreased, recorded deaths
from Alzheimer’s disease increased 123
percent between 2000 and 2015. The
sixth leading cause of death, the new
report stated Alzheimer’s is the only one
among the top 10 causes of death that
cannot be prevented, cured, or significantly slowed.
In addition to the human toll, the
financial cost is staggering. The 2018
Alzheimer’s Association report cited
a $277 billion cost to the nation for
Alzheimer’s and other dementias with a
projection that those costs could rise to as
much as $1.1 trillion by 2050. The current cost represents nearly a $20 billion
increase over last year.

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Plan of Action

Conant noted that in 2011, landmark
legislation laying the groundwork to create a national Alzheimer’s strategy was
(CONTINUED ON PAGE 6)

Same Convenient Location
MAY 2018

>

5

Alzheimer’s Association Sees Increase in Federal Support, continued from page 5
signed into law. The National Alzheimer’s Project Act (NAPA) created an advisory council to make recommendations to
the Secretary of Health and Human Services in three key areas: research, clinical
care, and long-term services and support.
“That was the first time we really saw
the federal government put an emphasis
on Alzheimer’s funding and research,”
Conant said. She added with this latest
$414 million NIH increase earmarked for
Alzheimer’s and dementia research, federal funding has now risen to $1.8 billion.
A great deal of work is being done to
better understand the underlying mechanism of Alzheimer’s and related dementias,
and there are a number of promising drug
trials underway that hope to stop or slow
down disease progression. “We’re really
excited about the focus not only on treatment but on prevention,” said Conant.
“We just announced the 2018 launch
of the Pointer Study, which is a two-year

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clinical trial to look at multifactorial and
lifestyle interventions to prevent cognitive
decline and dementia,” she continued. The
intervention methods will include exercise,
nutritional counseling, cognitive and social
stimulation, and improved self-management of health conditions. For more information, go online to alz.org/us-pointer.

Kevin & Avonte’s Law

Also included in the omnibus bill
was funding for Kevin and Avonte’s Law,
bipartisan legislation to protect seniors
with dementia and children with developmental disabilities who are prone to
wander. Conant said AIM has spent
several years working on the bill, which
reauthorizes the Missing Americans Alert
Program through fiscal year 2022 and
expands the program to include those
with developmental disabilities.
Introduced by Reps. Chris Smith
(R-NJ) and Maxine Waters (D-Calif.)
in the House and Sens. Chuck Grassley
(R-Iowa) and Amy Klobuchar (D-Minn.)
in the Senate, the new law provides up to
$2 million in grants each year to state and
local agencies for programs to prevent
wandering or locate missing individuals.

RAISE-ing Caregivers Up

Yet another legislative win for the
Alzheimer’s Association and AIM came
earlier this year with passage of the Recognize, Assist, Include, Support, and
Engage (RAISE) Family Caregivers Act.

“From the Alzheimer’s perspective,
we know there are more than 15 million
caregivers providing unpaid care to individuals,” said Conant. The 2018 Facts
and Figures report estimated these individuals provide 18.4 billion hours of care
valued at over $232 billion. Research has
shown caregivers of people with dementia
report higher levels of stress, depression
and worse health outcomes than those
caring for individuals without dementia.
In 2017, these additional stressors led to
Alzheimer’s caregivers incurring an extra
$10.9 billion in health costs.
Sens. Susan Collins (R-Maine) and
Tammy Baldwin (D-Wis.) and Reps.
Gregg Harper (R-Miss.) and Kathy
Castor (D-Fla.) introduced the bipartisan legislation. The new law directs
the Department of Health and Human
Services to develop a national strategy
to provide education and training, longterm services and supports, and financial
stability and security for caregivers.
Conant said her organization worked
closely with AARP to push for passage of
RAISE, which was modeled off of NAPA.
“It will require a plan to be updated
annually,” Conant said. “It’s also going
to create a National Family Caregiving
Council to provide recommendations to
the (HHS) Secretary.”

Providers & Care Planning

Conant said the Health Outcomes,
Planning and Education (HOPE) for

Alzheimer’s Act that passed in November
2016 provides a funding mechanism for
providers to be reimbursed for assessing
and discussing a diagnosis of Alzheimer’s
disease and available treatment and support options to improve or maintain quality of life.
“Beginning in 2017 for the first time,
people living with Alzheimer’s now have
access to care planning with a medical
professional, and it’s paid for by Medicare,” she said, adding the Alzheimer’s
Association has a downloadable care
planning toolkit for providers. For more
information, go online to alz.org/careplanning.

Moving Forward

“The goal is to prevent or effectively
treat Alzheimer’s by 2025,” said Conant.
“We’re excited about our progress, but
we know we have a long way to go.”

The Department of Surgery in the
College of Medicine at the University
of Tennessee Health Science Center
has launched the UTHSC Global Surgery Institute to coordinate, support,
and expand surgical mission work done
around the world by faculty and students.
Nia Zalamea, MD, an assistant professor of surgery, and Martin Fleming,
MD, chief of surgical oncology and associate professor of surgery, are the organizers
of the institute, which will anchor surgical mission work across the department,
assist residents and students interested in
mission work, and apply lessons learned
around the globe to local delivery of clinical care.
â&#x20AC;&#x153;It ties all of our separate projects into
one home base,â&#x20AC;? Dr. Zalamea said during
the announcement late last month.
Dr. Zalamea has done medical mission work annually in the Philippines since
1999 with her father, a nurse anesthetist,
and mother, a nurse, both of whom were
born in that country and came to Memphis in the 1970s. The family founded the
Memphis Mission of Mercy, a 501 c (3)
non-profit, and has made yearly missions
to the Philippines since. Dr. Fleming has
participated in medical missions to the
Philippines with Dr. Zalameaâ&#x20AC;&#x2122;s organiza-

PHOTO BY MATT DUCKLO/MEMPHIS MISSION OF MERCY

UTHSC Department of Surgery
Launches Global Institute

Dr. Nia Zalamea with patients and their family members during a medical mission in the Philippines.

tion and to Tanzania to teach and perform clinical work.
â&#x20AC;&#x153;Within the Department of Surgery,
weâ&#x20AC;&#x2122;ve organized ourselves because there
are all of these projects happening all over
the world,â&#x20AC;? Dr. Zalamea said.

A survey done during the organizational phase showed approximately 20
surgical faculty members at UTHSC were
providing 58 weeks of mission work each
year around the globe on their own time.
(CONTINUED ON PAGE 8)

Dr. Nia Zalamea

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to-day staff operations. They spearhead
hospital management issues such as quality of care, patient safety, patient and family experience, nursing standards of care,
leadership development, succession planning, personnel management and budgetary responsibility.
Recently, in honor of National Nurses
Week, May 6-12, a group of five CNOs
took a critical and compassionate look at
key issues facing chief nursing officers in
the Mid-South today at a roundtable discussion conducted by Pamela Harris, publisher of the Memphis Medical News.
They discussed the nationally high
turnover rate of CNOs, the challenge of
retaining a reliable staff, current nurse recognition practices and how their personal
experiences have assisted them professionally over the years.
Participants in the discussion were:
- Kathy Barnes, CNO, Methodist Le
Bonheur Germantown Hospital
- Susan Ferguson, vice president
and system chief nurse executive, Baptist
Memorial Health Care Corporation
- Wanda Rook-Peperone, CNO,
Saint Francis Hospital, Bartlett
- Lisa Schafer, COO and
CNO, Regional One Health
- Kathleen Seerup, vice president of
patient care and CNO, Le Bonheur Children’s Hospital

High Turnover

All five CNOs agreed that turnover
among CNOs is high nationally. Three of
the five CNOs present at the roundtable
discussion have been in their roles for less
than one year and the other two for less
than five years. This reflects a national
trend.
According to the American College
of Healthcare Executives, CNOs tend to
stay in their roles for two and a half to
8

>

MAY 2018

five years. Saint Francis’ Rook-Peperone
agreed this national trend is reflected in
the Mid-South.
“The average CNO stays in the position from three to eight years in the Memphis area,” she said. “It’s a tremendous
responsibility as it takes time to get settled
into the role and build a team which
builds longevity.”
All five experts said CNO turnover is
related to many changing factors, including hospital CEO turnover, the retirement
of longtime CNOs, job availability and
location.

Regional One’s Schafer said the hospital CNO and CEO work together to
build a long-term strategic plan for the
healthcare system. As a result, she said
the greatest turnover happens in hospital
executive management when the CEO
leaves an organization.
“The CNO and CEO have a synchronized partnership,” she said. “A new
CEO wants to choose the CNO on his or
her team.”
Although statistics could not be
found for the rate of national CNO turnover, hospital CEO turnover remains at
18 percent for the third consecutive year,
according to a report by the American
College of Healthcare Executives. Continuous consolidation of healthcare organizations over the past decade and retiring
leaders from the baby boomer era influence these turnover rates.
Seerup, of Le Bonheur Children’s
Hospital, agreed that many longtime
CNOs at hospitals are retiring, especially
in pediatric hospitals.
“There wasn’t CNO turnover in
pediatrics nationally until recently,” she
said. “Within the last 18 months there
have been a large number of CNOs retiring. Generally, CNOs at pediatric hospitals were in the position for a long time.
The CNO worked for the same hospital
and grew within the organization.
“Now, you must step outside the organization to advance. You must move to a
larger-scope children’s hospital because
the same CNO or CEO have been in the
same position for a long time.”
Barnes, the CNO with Methodist
Le Bonheur Germantown, said job availability is a factor for many potential CNO
candidates. There aren’t enough leadership positions available at every hospital.
“There are fewer opportunities for
advancement the higher up in leadership

Nursing experience – A 30-year Baptist
employee, she has served in a variety
of roles throughout the system, most
recently as system nursing director for
clinical value analysis/specialty care/
patient safety. Prior to serving as the
system nursing director, Ferguson
was BMH-Collierville’s CNO; system
director of nursing; director of nursing
administration; director of oncology
services; and CNO for Baptist in the
metro-Memphis area, West Tennessee
and East Arkansas. She began her career in B

Credentials – Received the Tennessee Organ
for Excellence in Nursing Leadership in 2009,
2015, was president from 2011-2013. Served
College of Nursing. She is a registered nurse

you go, so you must be prepared to move
to a new health system,” she said. “There
is only one CNO and CEO position for
each hospital.”
Ferguson, the vice president and system chief nurse executive with Baptist,
said location plays a role in CNO turnover. She has seen CNO turnover lower
in rural areas in the Mid-South.
“In a rural community,” she said,
“the CNO has usually been a nurse for a
long time at that facility. There is more
competition in a big city. Succession planning is so important and must be in place
for when the CNO leaves.”
All CNOs agreed that it’s important
for hospitals to consider nurses for executive management positions as they have
a unique patient and staff perspective.
Ferguson said nurses hold four executive
management positions at Baptist.
Additionally, Barnes said it’s important when researching for a CNO position
to look at an organization as a partner.
“Look at the culture, values and practice style to make sure there is an affinity there,” she said. “It’s not a case of just
finding a job, but a partner.”

Retaining Good Staff

All five CNOs said it’s a challenge to
retain nurses with the many employment
options nurses have today, but the answer to
retaining good employees is to compassionately listen to them and let them know they
make a difference within the organization.
“In my experience, the main objective is for nurses to know they have a voice
within the organization,” Baptist’s Ferguson said. “It’s important that those in nursing leadership are visible and listen to the
staff. Nurses want to be heard and know
that they are part of making decisions.”
Acknowledging nurses in small ways
shows nurses they are valued.
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Baptist’s emergency department.

nization of Nurse Executives (TONE) award
, erved on the TONE Board from 2008d on Dean’s Advisory Board for Loewenberg
e and has a master of science.

“Small things mean a lot to a nurse,”
Le Bonheur’s Seerup said. “Sending a
birthday card or anniversary card to their
home is a small gesture that can go a long
way in letting someone know he or she
matters.”
Barnes, of Methodist Le Bonheur
Germantown, said the CNO must always
be visible and interact with employees.
“You have to be accessible,” she said.
“It’s important to leave your desk and
walk the hallways. Nurses are vital to an
organization. They provide exceptional
care at the most vulnerable of times. Be
available to them during troubling times.
Look at pictures of their children and
encourage them to have fun and advance
in their career.”
Schafer, at Regional One, said CNOs
must recognize nurses more within organizations. Both formal and informal recognition programs can go a long way in
retaining nurses.
“Engaging your staff and recognizing
them for their hard work is key,” she said.
“Our profession is trained to look at problems and make decisions. People want to
know they are valued, and it’s our job to
focus on them and recognize them.”

Nurse Recognition Matters

All five CNOs agreed that offering
nurses financial incentives to stay with
their current healthcare systems assists in
retention, but recognition programs give
nurses a sense of belonging to a family.
Ferguson said small incentives such
as offering continuing education and certifications and honoring nurses with the
DAISY Award for Extraordinary Nurses,
which is a national merit-based award recognition program, showcase that an organization invests in its nurses.
Rook-Peperone said that it’s important to research how nurses want to be
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recognized.
“For example,” she said, “bedside
nurses don’t like a lot of pomp and circumstance.”
Schafer said the element of surprise is
a fun way to recognize a nurse for his or
her work. She recalled a time at another
healthcare organization when the CNO
dressed in a trench coat and glasses and
played the theme to Mission Impossible as
part of a nursing recognition program.
The CNO gave pens to the nurses that
said “Mission Accomplished.”
Several CNOs said they receive
recognition themselves when their staff
achieves a milestone.
“I’m more metric driven,” Schafer
said. “My biggest thrill is when my team
achieves a goal we’ve been working toward.
It means more to me when something is
accomplished by the people I lead.”
Saint Francis’ Rook-Peperone said
that when former patients recognize nurses
for a job well done, it makes more of an
impression, as there is a personal connection between the patient and the nurse.
“It’s nice to see the staff react to reading letters from their family or to hear
from patients who received an exceptional
level of care,” she said. “When you’ve
touched your team in that way, you feel
like you’ve arrived.”
Barnes said a visit from a former
patient makes a personal and passionate
impact.
“It’s seeing a patient walk who
couldn’t before that makes such a difference in a nurse’s career,” she said. “As a
nurse, we only touch them at one point
during their sickness or recovery.”
For all CNOs, it’s meaningful for
them when a former co-worker contacts
them about how they made a difference
in his or her career.
“I received an email one time from

a nurse who I helped get employment,”
Seerup said. “She said, ‘Thank you for
helping me be the best nurse I can be.’
I couldn’t get a better compliment than
that. It makes a difference when you’ve
had an impact in someone’s life like that.
You never forget it. I get goose bumps just
thinking about it.”

Inspiring Experiences

All five CNOs had very different personal experiences that made a difference
in their career choices, but they all agreed
they were attracted to nursing because

Lisa Cox Schafer
Title, hospital -- Chief
Operating Officer and Chief
Nursing Officer, Regional
One Health.
Birthplace – Honolulu,
Hawaii.
Nursing School – University
of North Carolina, Bachelor
of Science in Nursing; and
Medical University of South
Carolina, Master of Science
in Nursing Administration.
Nursing experience –
Nursing management
and leadership roles for
more than 30 years in
academic medical centers
and community hospitals
including Scripps Health
System in San Diego, California; Roper Saint Francis Healthcare and the
Medical University of South Carolina.
Credentials – RN, MSN, NEA-BC (Nurse Executive Advanced-Board
Certified).

they wanted to help people and make
them better.
“I’ve always wanted to be a nurse,”
Rook-Peperone said. “When I was little I
would use toilet paper to wrap my dolls,
which I imagined were hurt and needed
care. It’s a privilege to be one.”
For Seerup, choosing to become a nurse
was more personal. She wanted to provide
the exceptional care that her brother didn’t
receive when he was terminally ill.
“I wanted to be an accountant at
first,” she said. “I had two personal experiences which convinced me that nursing
was the profession for me. My father had
a heart attack at 40 and survived and my
brother had metastatic brain cancer. I saw
how my brother wasn’t provided compassionate care, and I wanted to change that.
I wanted to provide compassionate care to
people who are sick and become a leader.”
Ferguson’s experience as a nurse was
valuable for her current role, but it wasn’t
until she was in hospital management that
she felt she learned the skills necessary to
be a hospital executive.
“It’s through the different leadership
positions I’ve held over the years where
I have learned the most, especially those
outside my skill set,” she said. “I learned
how rural hospitals work and how different they function in a small community.
For instance, they don’t have transportation services or a 24-hour pharmacy. As I
look back, one leadership role helped prepare me for the next.”
Schafer said it’s important to have a
broad perspective to be a CNO.
“Many CNOs come from a background in critical care and emergency
care,” she said. “It’s a fast-paced environment, and you have to make quick
decisions. This type of background helps
prepare nurses for future leadership roles.
You have to focus and stay on course.”
MAY 2018

>

9

UTHSC Department of Surgery at Launches Global Institute, continued from page 7
“That’s breathtaking,” Dr. Zalamea
said.
The physicians, many of whom, like
Dr. Zalamea, are affiliated with Methodist Le Bonheur Health Care, donate their
surgical skills to help people in China,
Vietnam, Honduras, Nicaragua, India,
and the Philippines, among many destinations.
The survey also showed 60 percent
of incoming residents were interested in
doing international work as part of their
training, and 65 to 70 percent of medical students had already been involved in
international work prior to residency, she

said.
“That’s a pretty moving statistic,”
she said. “Not only do they want it, but
they’ve already engaged in it,” Dr. Zalamea said.
The UTHSC Global Surgery Institute is a partner of the American College
of Surgeons, which links it with similar
organizations nationally and globally and
expands overseas opportunities and support.
A Global Surgery Support Fund has
been established through the UT Foundation to offer scholarships for travel
expenses to medical students, surgery

residents, and surgery fellows interested in
doing mission work.
To help fund the scholarships, the
Global Surgery Institute is holding its
first fundraiser May 11 from 6-10 p.m. at
The Brass Door, 152 Madison Avenue,
and the Madison Avenue Park across the
street. Admission is $10, or $5 with a student ID, and includes refreshments and
entertainment. Ethicon Endosurgery, a
manufacturer of surgical devices, is helping sponsor the event.
The UTHSC Global Surgery Institute includes an active student advisory
and support group. One of those students,

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>

MAY 2018

Janyn Quiz, 24, in her first year of medical school, grew up in the Philippines and
moved to the United States two years ago
with her family. “I’m really grateful for
my country, and I want to give back to
them as much as I can,” she said.

Filoteia Popescu, a Rhodes College
junior with majors in biochemistry and
molecular biology and
neuroscience, has published an article proposing a new procedure
for evaluating women
who experience recurrent pregnancy loss. She
published the article with
Rhodes biology professor Carolyn Jaslow and Filoteia Popescu
William Kutteh of Fertility Associates of Memphis in a March issue
of Human Reproduction, an international
peer-reviewed scientific journal.
The title of the article is “Recurrent
Pregnancy Loss Evaluation Combined
With 24-Chromosome Microarray of
Miscarriage Tissue Provides a Probable
or Definite Cause of Pregnancy Loss In
Over 90 Percent of Patients.” Research
participants included 100 women with
recurrent pregnancy loss (RPL) seen in
a private fertility clinic. All 100 women
had two or more pregnancy losses, a
complete evaluation for RPL as defined
by the American Society for Reproductive Medicine, and miscarriage tissue
evaluated by 24-chromosome microarray analysis after their second or subsequent miscarriage.
Popescu’s research role included
interpretation, analysis, and synthesis
of data, the original draft of the article,
manuscript review and editing, and critical discussion.
“That an undergraduate is the first
author on this type of publication is
extraordinary,” Jaslow said. “I think it
is likely that this article will change the
testing procedures for women seeking
help for RPL in fertility clinics throughout the world.”
RPL is frustrating for physicians to
treat, according to Popescu, and the
recommended workup could only identify probable causes for RPL about half
the time. The procedure that she and
her collaborators have proposed involves adding the 24-chromosome microarray analysis as the first step to the
standard RPL testing procedure.
“This step should not only allow physicians to identify a definite or probable
cause for pregnancy loss in more than
90% of patients, but it will also provide
substantial savings in overall healthcare
costs,” says Popescu.“It also is emotionally devastating for couples to experience recurrent pregnancy loss, and for
some patients, knowing the cause for a
loss may provide comfort. The proposed
procedure would provide patients with
those answers in a cost-efficient and timeefficient manner. I am thrilled that this
article has the potential to contribute to
new therapies and policies that can help
future couples.”
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GrandRounds

CONSOLIDATED MEDICAL
PRACTICES OF MEMPHIS

salutes the Engbretson Center for Women and the work of
its three providers.

Dr. Malone graduated from the University of Tennessee
College of Medicine at Memphis in 2007. She completed
her OBGYN residency training at the University of Tennessee
College of Medicine in 2011. She is a member of IHI
Committee Baptist Women’s Hospital here in Memphis.

The Clinical Trials Network of Tennessee will support clinical research efforts across the UT
System. From left to right, Phil Cestaro, Karen Johnson, Chancellor Steve Schwab, Steven
Goodman, Robert Davis, Bill Mason, and Ari VanderWalde.

UTHSC Launches Clinical Trials Network of Tennessee
The University of Tennessee Health Science Center (UTHSC) has launched the
Clinical Trials Network of Tennessee (CTN2). Operating as a separate 501(c) (3) subsidiary of the University of Tennessee Research Foundation (UTRF), CTN2 was created to enable UTHSC clinical research faculty to design, solicit, and conduct robust
statewide clinical trials with the overarching goal of providing new therapeutics and
medical devices aimed at improving the health of all Tennesseans.
The Clinical Trials Network of Tennessee was the vision of Steven R. Goodman,
PhD, vice chancellor for Research at UTHSC.
“CTN2 will provide robust statewide clinical trials that will improve medical treatments, while providing UTHSC credit for the clinical trial contracts being
performed by its faculty who are located at participating hospitals throughout the
state,” Goodman said.
CTN2 will allow UTHSC faculty to respond to opportunities for clinical trials at
the speed of industry. The UT Board of Trustees committed $3 million in 2017 to
support the first three years of CTN2 operations, and on March 23, 2018 the board
agreed to release the first-year funds to UTRF, which will then fund CTN2.
“Based on UTRF’s experiences supporting other projects across UT, we’ve established CTN2 as a nonprofit UTRF subsidiary and set up the bylaws to ensure that
its governing board represents all of the stakeholders,” said Richard Magid, PhD,
vice president of UTRF at UTHSC. Dr. Magid has also been elected to serve as the
UTRF board representative for CTN2.

THANKS FOR
READING

Memphis Medical News!
FOCUS TOPICS FOR OUR JUNE ISSUE:

Dermatology • Dentistry
Aesthetics • Men’s Health • MIPS

To be notified when the next issue is posted online,
please send your email address to
pamela@memphismedicalnews.com.

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Dr. Engbretson has practiced obstetrics
and gynecology in the Memphis area since 2007. She
is in private practice but also focuses on underserved
neighborhoods in the Memphis area via the Morning Center, a
mobile maternity unity providing charitable prenatal care.
Kathleen Behnke, FNP, has joined the Engbretson Center for
Women as our nurse practitioner and will offer personalized
care including a wide range of in-office patient care including
well woman exams, and pre and post-natal care. Behnke
received her Master’s of Science in Nursing from the
University of Tennessee Health Science Center in 2008.

OIG Offers Online
Access to Compliance
Resources
By Denise Burke
A virtual reality room at the new UTHSC Center for Healthcare Improvement and Patient
Simulation (CHIPS). The room will allow students to practice simulated endoscopies, ultrasound
procedures, and robotic surgeries.

UTHSC to Open $39.7 Million Center for Healthcare
Improvement May 11
The University of Tennessee Health Science Center (UTHSC) plans to open its $39.7
million Center for Healthcare Improvement and Patient Simulation (CHIPS) on May 11.
The 45,000-square-foot, facility at 26 South Dunlap is dedicated to education, research, and professional development of enhanced clinical skills using standardized
patients (actors trained to portray patients), high-fidelity patient simulators (manikins
costing from $15,000 to $220,000), and virtual reality technology. According to university officials the building, which has been under construction since 2015, is the only one
of its kind in Tennessee and one of only a handful in the country built for and totally
dedicated to simulation training.
The center will allow students from the six colleges at UTHSC – Dentistry, Graduate Health Sciences, Health Professions, Nursing, Medicine, and Pharmacy – to train
together in simulation settings to develop their skills in delivering team-based health
care, which is the proven model for the highest-quality care today.
Each floor of the three-story building is dedicated to a different aspect of simulation
training. The first floor includes bed-skill stations that will allow students to focus on preclinical skills and assessments. A virtual reality room allows students to practice simulated
endoscopies, ultrasound procedures, and robotic surgeries. There is also a simulated
home environment, where students can practice delivering in-home patient care.

Methodist North Hospital
President Receives Honor
Florence Jones, president of Methodist North Hospital, is one of four outstanding Murray State
alumni to receive the
2018
Distinguished
Alumni Award presented last month during
an awards dinner on
the campus.
Jones, a 1975 nursFlorence Jones
ing alumna, has served
more than 25 years in
the healthcare industry and has broken
through countless barriers of gender
and race throughout her years of experience. Jones has established a reputation for collaborative and inspirational
leadership during her career. She also
served the U.S. as a first lieutenant in
the Army Nurse Corps for the United
States Army Reserve from 1977 to1980.
Established in 1962, the Distinguished Alumni Award is presented annually to alumni who have made meaningful contributions to their professions
on a local, state and national level. It is
the highest honor an alumnus can receive from the Murray State Alumni Association.
Prior to becoming president of
Methodist North, Jones served as chief
nursing officer and interim president for
Methodist North and chief nursing officer for Methodist South.

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UTHSC Assistant Professor
Receives Research Grant

Brian M. Peters, PhD, assistant professor in the Department of Clinical
Pharmacy and Translational Science in the
College of Pharmacy
at the University of
Tennessee Health Science Center (UTHSC)
has been awarded
$418,000 to continue
Brian Peters
his research repurposing compounds to fight
against inflammation that results from
vulvovaginal candidiasis (VVC) -- commonly referred to as a yeast infection.
VVC is among the most prevalent fungal
infections found in humans -- 75 percent
of women suffer from this condition at
least once in their lifetime.
“Current therapies for VVC are focused mostly on antifungal administration, which for the most part, is fairly effective,” Peters said. “But there is a subset of women (five to eight percent) who
have recurrent disease and have to maintain that antifungal therapy throughout
their lives, or they will continue getting
symptoms over and over again.”
Peters and his team are attempting to develop a potential way to treat
VVC by repurposing FDA-approved
compounds found in common therapies used to treat other diseases, such
as type-2 diabetes. This new potential
inflammation therapy would be used as
a co-therapeutic to common antifungal
therapies.

A new website offering “one-stop shopping” to healthcare
organizations and providers seeking assistance with compliance
efforts has been launched by the Office of the Inspector General
(OIG) in conjunction with the Department of Health and Human
Services (HHS).
The site is well organized and can provide managers and
compliance officers with compliance guidance and training
materials to support their compliance programs. In its role, the
OIG serves as an independent and objective oversight authority
over programs operated by HHS, including the Centers for
Medicare and Medicaid Services (CMS), public health agencies
(such as the Centers for Disease Control and Prevention) and
human resources agencies (such as the Administration for
Children and Families).
The website (available at oig.hhs.gov/compliance) offers a
wide range of public resources, including:
• Compliance toolkits
• Provider compliance resources and training
• Advisory opinions
• Voluntary compliance and exclusions resources
• Provider compliance resource and training
• Special fraud alerts, other guidance, and safe harbors
• Resources for health care boards
• Resources for physicians
• Accountable Care Organizations
Under the Toolkits section, for instance, there are resources
for measuring compliance program effectiveness, dealing with
adverse events and a guide for building
The Author:
and operating healthcare boards. The site
will continue adding new resources over
time, including a soon-to-be-released
guide on identifying patients at risk for
opioid misuse.
The site offers a roadmap tool for new
physicians, along with some opportunities
for continuing education. There’s also a
special section specifically for accountable
care organizations.
The site is also a good resource for
staying on top of recent OIG guidance,
including advisory opinions, fraud alerts
Denise D. Burke is an
and safe harbor regulations.
attorney with Waller in
The OIG Work Plan, which had
Memphis.
previously only been updated once or
twice a year, is now updated monthly online. The OIG Work Plan
serves as “advance notice” to providers of specific risk areas that
will receive attention from the OIG, outlining upcoming OIG
audits and evaluations that are underway or plan during the
current fiscal year and beyond.

An article published by the IQVIA
Institute for Human Data Science (“Medicine Use and Spending in the U.S.,” April
2018) reports that Tennesseans filled
6,709,154 opioid prescriptions at retail
pharmacies in 2017, close to a 9 percent
decrease from the previous year and a
21.3 percent drop from 2013.
The report states that Tennessee outperformed most of its contiguous states
and is on par with the national average
for year-over-year improvements and fiveyear trends.
The Tennessee Medical Association,
the state’s largest professional organization for doctors, says the data is “validation of the medical community’s ongoing
efforts to self-regulate prescribing and
reduce initial opioid dosage and supply.”
National trends show 22.2 percent
fewer opioid prescriptions were filled in
2017 than h in 2013, with every state in
the nation showing some reduction in
the past year. In 2017, a total of 196 million opioid prescriptions were filled in
the U.S., representing an 8.9 percent decrease from the prior year – the sharpest
single-year decrease reported by IQVIA.
Prescription opioid volumes in the U.S.
peaked in 2011 at 240 billion milligrams of
morphine milligram equivalents and have
declined by 29% to 171 billion MMEs.

Is
the missing

Saint Francis Hospital-Bartlett has
been honored with an “A” Hospital Safety Grade by The Leapfrog Group, an organization that hopes to improve health
care quality and safety for consumers.
Saint Francis Hospital-Bartlett officials said their facility was the only one in
Shelby County to receive the “A” Hospital Safety Grade. It is the ninth consecutive “A” grade for Saint Francis HospitalBartlett.
The Leapfrog Hospital Safety Grade
assigns letter grades to hospitals nationwide based on their performance in preventing medical errors and infections. The
grade is designed to provide consumers
with information they might want when
making decisions about a hospital stay.
The Leapfrog Hospital Safety Grade
is calculated by using 27 measures of
publicly available hospital safety data.
Approximately 2,500 hospitals have been
assigned scores, with less than a third receiving an “A” grade.

Baptist Adds New Feature to
Its Telehealth Services
Baptist Memorial Health Care has
added a telehealth component to its
metro and regional facilities that is designed for intensive care unit patients.
Through new eICU monitoring technology, known as TeleGuardian, speciallytrained ICU registered nurses in Baptist’s
TeleHealth Center based in Memphis will
work directly with the hospital’s intensive
care and critical care teams, serving as
real-time support and collaborating with
teams on the floor.
A camera and monitor mounted on
the wall in one of the hospital’s intensive
care units, nurses in Memphis can view a
patient in real time, said Stacy Hammett,

director of Baptist’s eICU, who Hammett
helped direct the launch of eICU in 12 of
Baptist’s 21 hospitals.
Patients benefit in several key ways,
including:
• Higher overall survival rates
• 24/7 remote patient monitoring by
experienced critical care nurses who can
answer questions or discuss patient care
• Education and mentoring for newer
ICU nurses
• Changes in patients’ conditions
are quickly identified in real time and addressed immediately to help avoid complications during recovery.
• Shorter lengths of stay in the unit
for some patients
• Fewer days on a ventilator
• Lower rate of preventable complications, such as pneumonia and sepsis

Dr. Winblad is a
graduate of University of
Kansas School of Medicine and completed Diagnostic Radiology Residency training at University of Kansas School of
Medicine, Wichita. Dr. J. Bret Winblad
Winblad completed an
Interventional Radiology Fellowship at Alleghany Health Network, Pittsburgh.
Dr. Winblad is Board Certified in
both Diagnostic Radiology and Interventional Radiology. His special interests are
in Peripheral Vascular Disease and Liver
Cancer.

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